Cited by 295Vascular Malformations Diagnosis and TreatmentRadiation Therapy and DosimetryVascular Malformations and Hemangiomas

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Stereotactic Heavy-Charged-Particle Bragg-Peak Radiation for Intracranial Arteriovenous Malformations

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Steinberg, Gary K., Fabrikant, Jacob I., Marks, Michael P., Levy, Richard P., Frankel, Kenneth A., Phillips, Mark H., Shuer, Lawrence M., Silverberg, Gerald D.·1990·New England Journal of Medicine

DOI 10.1056/nejm199007123230205

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Abstract

BACKGROUND: Heavy-charged-particle radiation has several advantages over protons and photons for the treatment of intracranial lesions; it has an improved physical distribution of the dose deep in tissue, a small angle of lateral scattering, and a sharp distal falloff of the dose. METHODS: We present detailed clinical and radiologic follow-up in 86 patients with symptomatic but surgically inaccessible cerebral arteriovenous malformations that were treated with stereotactic helium-ion Bragg-peak radiation. The doses ranged from 8.8 to 34.6 Gy delivered to volumes of tissue of 0.3 to 70 cm3. RESULTS: Two years after radiation treatment, the rate of complete obliteration of the lesions, as detected angiographically, was 94 percent for lesions smaller than 4 cm3, 75 percent for those of 4 to 25 cm3, and 39 percent for those larger than 25 cm3. After three years, the rates of obliteration were 100, 95, and 70 percent, respectively. Major neurologic complications occurred in 10 patients (12 percent), of whom 8 had permanent deficits. All these complications occurred in the initial stage of the protocol, before the maximal dose of radiation was reduced to 19.2 Gy. In addition, hemorrhage occurred in 10 patients from residual malformations between 4 and 34 months after treatment. Seizures and headaches were less severe in 63 percent of the 35 and 68 percent of the 40 patients, respectively, who had them initially. CONCLUSIONS: Given the natural history of these inaccessible lesions and the high risks of surgery, we conclude that heavy-charged-particle radiation is an effective therapy for symptomatic, surgically inaccessible intracranial arteriovenous malformations. The current procedure has two disadvantages: a prolonged latency period before complete obliteration of the vascular lesion and a small risk of serious neurologic complications.

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“[20] However, they highlighted two disadvantages of that time technique; small risk of neurological complications and the long time interval of complete obliteration.[20]”
BackgroundInfluential

Authors: Steinberg, G. K., Fabrikant, J. I., Marks, M. P., Levy, R. P., Frankel, K. A., Phillips, M. H., Shuer, L. M., & Silverberg, G. D.
Affiliations: Stanford Medicine (US)
Lawrence Berkeley National Laboratory (US)
ORCID: Steinberg, Gary K.
Marks, Michael P.
Shuer, Lawrence M.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1990-07-12
Volume: 323
Issue: 2
Pages: 96-101
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199007123230205
OpenAlex: W2037803738
Cited by: 295
References: 23
Citations by year: 2025: 1 · 2024: 3 · 2022: 4 · 2020: 3 · 2018: 1 · 2016: 4 · 2015: 8 · 2014: 7 · 2013: 5 · 2012: 9
FWCI: 17.10
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Clinical Neurology › Vascular Malformations Diagnosis and Treatment
Physical Sciences › Physics and Astronomy › Radiation › Radiation Therapy and Dosimetry
Health Sciences › Medicine › Surgery › Vascular Malformations and Hemangiomas
Keywords: intracranial arteriovenous malformations, helium ion therapy, stereotactic radiotherapy, Bragg peak, neurological complications, hemorrhage, seizures, headache
MeSH terms: Adolescent, Adult, Aged, Cerebral Angiography, Intracranial Arteriovenous Malformations, Cerebral Hemorrhage, Child, Female, Follow-Up Studies, Helium, Humans, Male, Middle Aged, Radiotherapy, Radiotherapy Dosage

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Stereotactic Heavy-Charged-Particle Bragg-Peak Radiation for Intracranial Arteriovenous Malformations

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